Provider Demographics
NPI:1477564375
Name:HOME THERAPY INC.
Entity Type:Organization
Organization Name:HOME THERAPY INC.
Other - Org Name:ACTIVE MEDICAL & MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-632-9820
Mailing Address - Street 1:119 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-4961
Mailing Address - Country:US
Mailing Address - Phone:731-632-9820
Mailing Address - Fax:866-430-7946
Practice Address - Street 1:135 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2315
Practice Address - Country:US
Practice Address - Phone:731-632-9820
Practice Address - Fax:866-430-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000939332B00000X, 332BC3200X, 332BX2000X
MS02564/02.03336H0001X, 3336L0003X, 3336M0002X, 3336S0011X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040342Medicaid
AL100230069Medicaid
TN4581588Medicaid
MS000011213OtherBCBS, PPO
TN0132771OtherBCBS, HIT
MS00330076Medicaid
TN172669Medicaid
MS000011210OtherBCBS
TN310-5120OtherBCBS
TN9250047Medicaid
AL100230069Medicaid
TN4581588Medicaid
AL100230069Medicaid